‘Tis the season to celebrate compassion: The reason we became surgeons

Issue: December 2010

ByDouglas W. Jackson, MD

Douglas W. Jackson

As we come to the end of another year, it is a tradition to reflect on the past 12 months during the holiday season. For most of us during this time of year, our work load usually lightens a bit and we have an opportunity to spend more quality time with loved ones. In the spirit of the holidays, this is a good time to recharge our individual compassion for our patients, family and friends.

Compassion differs from other behavior as it focuses on recognizing and understanding the needs of others with the underlying idea of doing what we can to alleviate their suffering and/or help them. Compassion is one of the main reasons most of us went into the field of medicine.

Cynicism and loss of idealism

An important priority for physicians should be for us to maintain our compassion not only throughout the year, but throughout our entire careers. However, this goal can be insidiously challenged by the demands and outside forces that we experience in our daily practice. Increasingly, we are experiencing the endlessly frustrating aspects and demands of managed care by those working in either a fee-for-service or salaried model. There are pressures to treat more patients, perform more documentation and sign more paperwork and forms. In addition, we are all functioning with less autonomy and there will be further continued challenges to our independence as we are forced to follow new mandates and guidelines. Most of us have practiced by our own standards and ethics for patient care and the changes that are occurring that question us at every turn and often provoke anger and frustration.

When we started out as physicians we were all quite idealistic and highly motivated to work hard to help our patients and minimize their suffering. As early as my second year of medical school, the associate dean called us into a special assembly because he and other administrators felt they were seeing an increasing amount of cynicism and loss of our idealism in our class members. I was never certain exactly what their concerns were based upon, but I wonder what they would feel if they assembled our class these 40-plus years later.

Compassion: Can it be taught?

It is my impression that those who choose medical careers do so because they have compassion which can be nurtured and reinforced — your compassion grows as one immerses him or herself in patient care. I am always impressed that despite the stresses and strains of our practices and personal lives that most physicians remain quite compassionate. I don’t feel that anyone without that level of inherent compassion could survive in medicine as a profession.

Focus on the positive

I often avoid sitting down in the doctor’s dining room for a meal because much of the conversations are complaints which require too much energy to defend or refute. We all are tempted to complain about things that we cannot control and to some degree are comforted commiserating with discontented colleagues— misery loves company. It is easy to fall into the habit of complaining, but I can only be around so much of it and it makes me feel worse. One of our Orthopedics Today Editorial Board members, Donald H. Johnson, MD, FRCSC, related a story of how he was feeling unusually down and couldn’t figure out why. After a while, he realized his daily running partner would complain throughout their entire daily morning pre-work jog. He started running alone and felt immediately uplifted. Medicine can be such a constructive environment and we have much to share that is positive and appreciated when sharing our feelings.

However, the Patient Protection and Affordable Care Act (PPACA) may ultimately change our practices. There are no mandates or guidelines that can require or measure compassionate medicine. There are no billing codes for compassion. Whatever the governmental bureaucracy imposes on our practices, only individual physicians will control their compassion and their reputations. These cannot be taken from us; we can only give them away.

Technician or friend (both)

Even as orthopedic surgeons who are technically and surgically oriented, we should not lose the important aspects of the patient/physician relationship that both we and our patients need. I had a mentor who used to tell me that patients sought him out because of his technical skills and they were not looking for a friend. Competence first and compassion second, he stated. We should not have to make that choice. We all can be compassionate while giving the most competent care. This can be achieved by being the kind of physician you want treating your family. Sometimes we need to remind ourselves that being a good doctor is not simply a matter of maintaining technical competence, but having the same level of compassion that we had when we entered medicine every day. Increasing demands have caused some physicians to be more reliant on diagnostic tests and histories taken by others and fail to really get to know the person they are treating.

Advice from the past

Many teachers in and outside of medicine have stressed extending genuine warmth and feelings for the needs of our patients and their families. It is through compassion we can experience the relationships that are the true source of satisfaction in practicing medicine. I would like to leave you with quotes that I have found meaningful and restorative for compassion:

Francis Weld Peabody, MD, in a 1927 address said, “for the secret of the care of the patient is in caring for the patient.”

Norman Cousins the well-known journalist and author noted, “The individual is capable of both great compassion and great indifference. We have it within our means to nourish the former and outgrow the latter.”

And Arthur Jersild a professor of psychology and education said, “Compassion is the ultimate and most meaningful embodiment of emotional maturity. It is through compassion that a person achieves the highest peak and deepest reach in his or her search for self-fulfillment.”

I would like to wish you all happy holidays and a new year full of compassion for your families, your friends and coworkers and your patients.

Douglas W. Jackson, MD, is Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Road, Thorofare, NJ 08086; e-mail: OT@slackinc.com.

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